Provider Demographics
NPI:1134303019
Name:HOPKINS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HOPKINS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-860-8650
Mailing Address - Street 1:4426 S KING DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3348
Mailing Address - Country:US
Mailing Address - Phone:708-860-8650
Mailing Address - Fax:708-897-0352
Practice Address - Street 1:1550 W 88TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-4828
Practice Address - Country:US
Practice Address - Phone:773-369-6264
Practice Address - Fax:708-897-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361117652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1637013OtherBLUE CROSS BLUE SHIELD OF IL
IL036111765Medicaid
IL213376Medicare PIN